Journal of Surgery and Trauma

en Cardiopulmonary Bypass Management in A Patient with Unilateral 100% Internal Carotid Artery Stenosis and Prior Stroke: A Case Report جراحی قلب Heart Surgery گزارش مورد Case Report Abstract Carotid artery stenosis is a major risk factor in open-heart surgery, significantly increasing the incidence of postoperative neurological complications and disabilities. Depending on the stenosis severity, this condition can exacerbate the risk of stroke and neurological dysfunction during cardiopulmonary bypass (CPB). The management of such patients necessitates strategic approaches in perfusion and physiological management to maintain adequate cerebral blood flow.The patient, a 69-year-old male with a history of myocardial infarction, was a candidate for coronary artery bypass grafting (CABG). Preoperative assessments revealed a complete occlusion of the internal carotid artery. Given the involvement of three major coronary vessels, the patient underwent on-pump open-heart surgery. The primary challenge was balancing cerebral perfusion pressure and acid-base management.Throughout the CPB procedure, the perfusion team employed a combination of Alpha-stat and pH-stat strategies intermittently and at strategic times. This approach aimed to maintain cerebral autoregulation while preventing significant alterations in blood carbon dioxide levels. Through this advanced management, the patient was closely monitored and navigated the critical phases of the surgery successfully. The patient was transferred to the intensive care unit postoperatively without any neurological sequelae or exacerbated cerebral complications and was eventually discharged in stable condition. This case demonstrates that although carotid stenosis poses a potential risk for neurological sequelae, the judicious integration of pH-stat and Alpha-stat strategies can effectively control and reduce the rate of cerebral ischemic complications during and after open-heart surgery. Cardiopulmonary Bypass, Internal Carotid Artery Stenosis, Stroke 224 227 http://jsurgery.bums.ac.ir/browse.php?a_code=A-10-168-15&slc_lang=en&sid=1 Ali Taherinezhad Ledari https://orcid.org/0000-0001-6207-6017 No Student Research Committee, Babol University of Medical Sciences, Babol, Iran. Medical Sciences Mahmoud Ganjifard fardganj@gmail.com https://orcid.org/0000-0002-8778-5394 No Department of Anesthesiology and Critical Care, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran Seyyed Ebrahim Hosseini Zargaz ebrahimhosseini134zargaz@gmail.com https://orcid.org/0009-0006-9048-3158 No Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran. Ahmad Amouzeshi amouzeshiahmad@gmail.com https://orcid.org/0000-0002-6271-3060 Yes Department of Cardiology, School of Medicine, Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.